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Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance cost in Wisconsin

HC Injection(S) Diagnostic/Therapeutic Agent Facet Lumbar/Sacral 2nd Level W/Image Guidance · CPT 64494

$643.42

lowest in Wisconsin

$1,002.76

state median

$3,955.05

highest in Wisconsin

$1,119.88

national median

Hospital	City	Cash price	Negotiated range	Payers
Midwest Orthopedic Specialty Hospital	Franklin	$643.42	$319.10 – $319.10	1
Ascension St. Francis Hospital, Inc.	Milwaukee	$643.42	$319.10 – $319.10	1
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	$643.42	$319.10 – $319.10	1
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	$661.77	$53.14 – $324.19	7
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	$661.77	$53.14 – $324.19	7
Ascension Calumet Hospital, Inc.	Chilton	$783.18	$53.14 – $324.19	7
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	$1,002.76	$81.86 – $354.45	6
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	$1,002.76	$81.86 – $354.45	6
UnityPoint Health - Meriter Hospital	Madison	$1,027.20	$46.42 – $155.04	13
SSM Health St. Clare Hospital - Baraboo	Baraboo	$1,072.50	$1,676.00 – $1,676.00	1
SSM Health Monroe Hospital	Monroe	$1,220.45	$2,181.00 – $9,837.00	2
SSM Health St. Mary's Hospital - Janesville	Janesville	$3,022.80	$1,704.00 – $1,704.00	1
SSM Health St. Mary's Hospital - Madison	Madison	$3,547.50	$2,036.00 – $2,036.00	1
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	$3,955.05	$433.00 – $5,512.00	4
SSM Health Waupun Memorial Hospital	Waupun	$3,955.05	$433.00 – $5,512.00	4
SSM Health Ripon Community Hospital	Ripon	$3,955.05	$433.00 – $5,512.00	4
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$949.00 – $16,897.00	6